State funding discriminates against private nursing homes



Headlines warning of a tsunami of nursing home closures earlier this month must have sent waves of concern coursing through thousands of families in Ireland. The crisis in the nursing home sector arises because of a shortfall in funding in the Fair Deal scheme, leaving vulnerable older folk and their families facing insecurity over their future care.

The whole point about the Fair Deal scheme was that it was intended to provide affordability and peace of mind for families and their elderly relatives, many in need of 24-hour care or suffering from dementia.  Around 80% of the 30,000 residents in nursing homes are supported by the Government’s Fair Deal scheme where the individual pays 80% of their income and 7.5% of the value of their home above an initial €36,000 and the Government pays the shortfall via the National Treatment Payment Fund (NTPFT)

“It takes a whole load off your mind,” says the daughter of an elderly friend who is in a private nursing home. “If it closed Mammy would have to come home to me. She needs 24-hour care. I would have to give up my job and it would create a huge amount of pressure.”

The family are already fully stretched with four school-going children and there is no way that they could meet the cost for private nursing home care at an average cost of €1,200 t0 €1,500 a week.

Indications of a looming crisis in the care sector – where the subvention simply doesn’t stretch to cover the cost of care in the private sector – have been there for months. In the last year, 20 private nursing homes have closed. “This year unless something changes another 20 or 30 will close,” warns Tom Finn of 11 strong Silver Stream Healthcare group .

So far, despite calls from the representative body for 460 homes, Nursing Homes Ireland (NHI), to implement measures to bring stability to the sector, the only official response has been a temporary scheme to offset increased costs. “It’s not fit for purpose, it’s not consistent with the increased costs involved in food electricity and staffing,” says Michael McGlynn Communications and Research Executive for NHI. At the same time an intended policy paper on the future of the sector has been stalled.

To exacerbate matters further, the already yawning gap between payments for HSE nursing homes and those in the private sector has widened still further. “While the funding crisis has led to the closure of more than 20 nursing homes in the last year, the already considerable gulf in payments to HSE nursing homes has increased, they are now receiving on average €800 extra funding per resident per week. These fees signify the reality of nursing home costs,” comments Tadhg Daly, CEO of NHI.

In Co Kilkenny the disparity between payments to HSE homes and private and voluntary care homes under the Fair Deal Scheme is among the widest at around €1,025 per week per individual. In January 2022 the disparity was €812, an indication of how payments to HSE homes have allowed for inflation while those the private homes have not.

“The chasm in how the State funds its own nursing homes represents discrimination against private nursing home residents and those entrusted with meeting their health and social care needs. It also has a direct effect on the ability of private nursing homes to appropriately renumerate and retain vital staff. A Fair Deal that is fair to all providers should be underpinned by the principle of equal pay for equal work,” says Tadhg Daly.

A consequence of the gap in payments are staff shortages in many homes, while another is the way  families may have to pay a couple of hundred euro a month for extras like occupational therapy.

The number of over 65s is set to double by 2051, whereas at present they represent 14% of the population. By mid-century one in every four will be over 65 and thus there will be a greater need for nursing homes in future.  While the majority who are now living longer also remain healthy for longer, inevitably the demand for residential care will increase. Vulnerable older people unable to live independently with health challenges really need properly funded care. Both they and their families want peace of mind and reassurance that care facilities can continue to operate.

They deserve a Fair Deal not an unfair one.

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